11. Communicating with the Dental Laboratory Flashcards
Dentist Guidelines
n Provide ____ instructions to laboratory (and retain duplicate)
nClearly written and understandable
nDetail work to be performed
nDescribe materials to use n Coloration
n Written description, photograph, drawing, shade tab
written
Dentist Guidelines
n Provide accurate:
n ____
n Casts
nOcclusal ____ nMounted casts (where indicated)
n Dentist should identify crown ____ (where indicated)
n Dentist should properly clean and ____ all items before sending
impressions
registrations
margins
disinfect
Technician Guidelines
nTechnician should follow guidelines of written instructions from dentist
nTechnician should ____ written instructions
nWritten instruction forms provided by the lab should include ample ____ for dentists written instruction
nTechnician should return case to check ____, if possible inaccuracy
retain
space
mounting
Technician Guidelines
nTechnician should match ____ indicated
nTechnician should return work in a timely manner
nTechnician should follow ____ control standards
shade
infection
Work Authorization
n General description of restoration to be made n Material specification n Desired occlusal scheme n Location of \_\_\_\_ n Specify \_\_\_\_ or metal contacts n Diagnostic \_\_\_\_ helpful for scheme n \_\_\_\_ design for fixed dental prosthesis n Cast vs. post-ceramic soldered n \_\_\_\_ and substructure design n Including \_\_\_\_ for tissue contact
occlusal contacts porcelain wax-up connector pontic material
Work Authorization
n Substructure design for metal ceramic restorations
n Indicate if want to see entire ____ before cutback n Shade selection
n ____ of tooth helpful
n Custom shade tab
n ____ shade analysis
n Photograph
n Technician may see patient with dentist (where ____)
n Date of next scheduled patient ____ and stage of ____ required
wax up diagram digital lawful appointment completion
Work Authorization
n Shade distribution chart must be adequate to include details nSubtle \_\_\_\_ differences n \_\_\_\_ n \_\_\_\_ n \_\_\_\_
shade
hypocalcification
translucency
stains
Work Authorization n Additional information nDiagnostic waxing nCasts of provisional restorations n \_\_\_\_ n \_\_\_\_ edge position n \_\_\_\_ form nDigital images
midlines
incisal
coronal
Problems n Most common problems seen by dentist nPoor \_\_\_\_ adaptation nPoor \_\_\_\_ nPoor \_\_\_\_ contour n Overcontouring of cervical 1/3 nHaphazard \_\_\_\_ and substructure design
marginal
occlusion
axial
pontic
Problems n Most common problems seen by technician nInadequate \_\_\_\_ reduction n Esp. \_\_\_\_ n mystery \_\_\_\_ n Improper \_\_\_\_ nVagueness in \_\_\_\_ communication
tooth cervical 1/3 margins articulation color
Interim Cementation
n Sometimes recommended so patient and dentist could assess appearance and ____ over time
n Manage cautiously
nOften difficult to ____
n May mix interim cement with ____
n May apply only at ____
nMay loosen during function. If loosens:
n Uncomfortable/embarrassing for patient
n May result in ____ if patient does not
return (especially if an abutment loosens)
n Patient needs instructions regarding objectives, duration and importance of returning
function remove petrolatum margins caries
Interim Cements Main Clinic nTemp Bond NE (Kerr) nFynal (Denstply) in ADCC (honors) n\_\_\_\_ final cement nDycal (Dentsply) nIRM (Dentsply) nDurelon (3M/ESPE) n May use as \_\_\_\_ interim cement 2018
ZOE
long term
Introduction
nDefinitive cementation does not receive same attention to detail as other aspects of restorative dentistry
nCareless luting selection ____ discrepancies nImproper ____
nMay require ____ restoration off and remaking
margin
occlusion
cutting
Choice of Luting Agent
n Depends on ____ casting or adhesively bonded restoration
n Ex. Ceramic inlay or resin bonded FDP
n (1)Traditional water-based dental cements n Use for ____ and FDPs
n Not used where ____ is needed
n (2)Adhesive resins
n Necessary for some restorations
n ____ sensitive and can be difficult to use (newer self-etch formulations easier)
n Long term data justifying more general use with ____ limited
conventional
cast crowns
adhesion
technique
conventional castings
Dental Cements
n Most luting agents traditionally used for cast restorations are ____
n Susceptible to acid attack making them somewhat soluble in ____ fluids
n In vitro studies show this is independent of marginal ____ (up to certain critical value)
n Dissolution is mechanism in cement ____ (not disintegration)
cements
oral
width
erosion
(1)Zinc Phosphate Cement n Still used for \_\_\_\_ restorations n Adequate strength n Acceptable \_\_\_\_ thickness (25um) n Reasonable working time n Excess material easily \_\_\_\_ n \_\_\_\_ effects on pulp are well documented (phosphoric acid) n Take normal precautions n Not used when preparation is too close to \_\_\_\_
cast film removed toxic pulp
(1)Zn Phosphate Cement
Choice of Luting Agent
nDespite limited biocompatibility due to pulp irritation > long history of ____ (important!)
n Cavity ____ may protect pulp with no decreased retention
nRemains good option for luting restorations on otherwise normal, conservatively prepared teeth
nCrowns displayed increased resistance to ____ on preparations with minimal resistance form
success
varnish
dislodgement
(1)Zinc Phosphate Cement
n Examples
n____ (Mission)**
zinc cement
(2)Zinc Polycarboxylate Cement
n Biocompatible
n Large polyacrylic acid molecule does ____ penetrate
dentinal tubules
n Exhibits ____ to tooth
n Due to ____ chelation
n No adhesion to ____
n High viscosity makes mixing ____
n May use encapsulated products
n Claims of ____ long term retention
n May adversely change properties by adjusting powder/liquid ____
n ____ Powder/liquid ratio ____ solubility
n Also improved with encapsulated products
not
adhesion
calcium
castings
difficult inferior ratio decrease increase
(2)Zinc Polycarboxylate Cement
n Working time much shorter than ____
n 2.5 min compared to 5 min
n Problem with ____ units
n Residual cement more difficult to ____ than Zn phosphate
n Some studies show less ____ than Zn phosphate
n Limit to restorations with good retention and resistance
form where minimal ____ irritation is wanted
n May use as a base and to block out minor ____ on vital teeth
n Chemical interaction with ____
n Contraindicated cementing crowns on Ti abutments
Zn phosphate multiple remove retention pulp undercuts titanium (Ti)
(2)Zinc Polycarboxylate Cement
Choice of Luting Agent
nRecommended on retentive preparations when minimal pulp irritation is important
nEx. Children with ____ pulp chambers
large
(2)Zinc Polycarboxylate Cement
n Examples
n ____ (3M/ESPE)**
**Main clinic: Use for ____ cementation
durelon
temporary
(3)Glass Ionomer Cement
n Adheres to enamel and \_\_\_\_ n Exhibits good \_\_\_\_ n Releases \_\_\_\_ n May have anticariogenic effect n Has NOT been documented \_\_\_\_! n Set exhibits \_\_\_\_ n Advantageous with porcelain labial \_\_\_\_
n Mechanical properties ____ to zinc
phosphate and polycarboxylate cements
n ____ appearance when set
n Difficult to distinguish between ____ caries
n Difficult to distinguish ____
dentin biocompatibility clinically translucency margins
superior
radiolucent
recurrent
overhang
(3)Glass Ionomer Cement
n Susceptible to moisture ____ during setting
n protect with foil, resin coat or band of cement undisturbed for ____ minutes
nWater changes setting reaction resulting in water absorption > ____
nDo not ____ during initial setting
n Newer resin modified ____ ionomers are less susceptible to early moisture exposure
contamination 10 erosion dessicate less
(3)Glass Ionomer Cement
n Post operative ____ reports have not been demonstrated in clinical trials
nLittle ____ response found histologically
n May be due to dessication or ____
contamination
nEvaluate technique if sensitivity
nResin modified and self-adhesive resins show less post operative ____
nDesensitizing agent may prevent ____
n may decrease ____
sensitivity pulpal bacterial sensitivity sensitivty retention
(3)Glass Ionomer Cement
Choice of Luting Agent
nPopular cement for luting ____ restorations
nGood working properties
nMore ____ than zinc phosphate
nSets more ____ than zinc phosphate nEasily ____
casting
translucent
rapidly
mixed
(3)Glass Ionomer Cement
n Examples
n ____**, Ketac-Cem Aplicap (3M ESPE)
ketac-cam
(4)Zinc Oxide-Eugenol with and without Ethoxybenzoic Acid
nReinforced ZOE extremely \_\_\_\_ nProvides excellent \_\_\_\_ nLimited use due to inferior properties nCompressive \_\_\_\_* n \_\_\_\_* nFilm \_\_\_\_* --- all inferior to other luting agents (i.e Zn phosphate)
biocompatible seal strength solubility thickness
(4)Zinc Oxide-Eugenol with and without Ethoxybenzoic acid
n Ethoxybenzoic acid (EBA) modifier replaces portion of ____ in ZOE
nImproves ____ strength without affecting resistance to ____
n ____ working time
n Excess material difficult to ____
n Use only in restorations with ____ retention form
n When emphasis on ____ and pulpal protection needed
n Main clinic: ____ (Dentsply)
eugenol compressive deformation short remove good biocompatibility fynal
(5)Resin-Modified Glass Ionomer
Luting Agents
n Developed in 1990s
nCombine desirable properties of glass ionomer (____ release and adhesion) with higher ____ and low ____ of resins
n Less susceptible to early ____ exposure than glass ionomer
n Among the most ____ cements
n Minimal postcementation sensitivity
n Higher strength than ____ cements (similar to resin luting agents)
n Avoid with ____ restorations
nAssociated with ____ due to water absorption and expansion
fluoride strength solubility moisture popular conventional all-ceramic fracture
(5)Resin-Modified Glass Ionomer
Choice of Luting Agent
nAmong the most popular nLow ____
n ____
nLow ____
nPerceived benefit of reduced post cementation ____
nNot confirmed in clinical studies
solubility
adhesion
microleakage
sensitivity
(5)Resin-Modified Glass Ionomer Luting Agents
n Examples ____ (3M
ESPE)**
nFuji Plus (GC America, Inc.)**
RelyX
(6)Resin Luting Agents
nEarly products unsuccessful (1950s)
nhigh polymerization ____
npoor ____
nComposite resin cements with improved properties developed
nUsed for ____ ceramics nHave ____ properties
n Capable of bonding chemically to ____
shrinkage biocompatibility bonded adhesive dentin
(6)Resin Luting Agents
nImproved properties and lack of ____ increased use
nLess ____ than cements
nEx. Glass ionomer
nEspecially if not fully ____
n____ resins have lowest incidence of postcementation sensitivity
solubility
biocompatible
polymerized
self-adhesive
(6)Resin Luting Agents
n Categorized on basis of n____ method and presence of n____ bonding mechanisms
n Chemical-cure, light-cure, dual-cure
n Metal restorations n____ cured system
n Ceramics
n____-cured or n____-cured
n adhesive scheme classification
n n____ etch (etch, adhesive, cement) n n____ etch (primer and cement)
n Self n____ (one step)
polymerization
dentin
chemically light dual total self adhesive
(6)Resin Luting Agents
Choice of Luting Agent
nHigh n____ strength
nConcern regarding stresses caused by polymerization shrinkage, magnified in n____ films, lead to marginal leakage
nSelf etch systems increasingly popular
nSimplicity of traditional cements
nReduced n____ of traditional adhesive resins
nPatients appear to experience n____ incidence of post treatment n____
retention thin solubility lowest sensitivity
(6)Resin Luting Agents Choice of Luting Agent n Indications n\_\_\_\_ and \_\_\_\_ processed composite resin restorations nWhen casting has been displaced due to lack of \_\_\_\_
all-ceramic
laboratory
retention
Resin Luting Agents Main Clinic n Panavia V5 +Ceramic Primer (Kuraray) n \_\_\_\_ cure n \_\_\_\_ releasing n Panavia SA (Kuraray) n \_\_\_\_ adhesive/self etch n Clearfil esthetic cement (Kuraray) n \_\_\_\_ cure n Nexus III (Kerr) n \_\_\_\_ cure
n Variolink (Ivoclar) n \_\_\_\_ cure n \_\_\_\_ cure n Relyx Unicem (3M Espe) n \_\_\_\_ cure/Self adhesive
dual fluoride self dual dual light dual light dual
Choice of Luting Agent Ideal luting agent nLong \_\_\_\_ time n Adheres well to both tooth structure and restorative materials nProvides a good seal n\_\_\_\_ to pulp nAdequate strength properties nCompressible into \_\_\_\_ layers nLow viscosity and solubility nExhibits good working and setting characteristics nExcess easily \_\_\_\_
working
nontoxic
thin
removed
No single luting agent meets all of the ____ properties
ideal
Procedure Preparation of Tooth and Restoration n Decreased performance of luting agents if material is \_\_\_\_ nWater, blood, saliva nRestoration and tooth must be carefully \_\_\_\_ and dried
contaminated
cleaned
Procedure Rosenstiel SF et al., 2016 Preparation of Tooth and Restoration n Casting preparation n Clean n \_\_\_\_ cleaning n \_\_\_\_ n Organic solvents nAirborne particle abrasion of internal surface n 50um \_\_\_\_ n Increases retention of \_\_\_\_
steam
ultrasonics
alumina
casting
Procedure Preparation of Tooth and Restoration n Tooth preparation nremove interim luting agent nDo not \_\_\_\_ teeth (post operative sensitivity) nClean tooth n Pumice and/or chlorhexidine preparation (Consepsis) \_\_\_\_ dry
dessicate
gently
Procedure
n Inspect preparation surfaces for cleanliness
n Isolate area with cotton rolls and place saliva evacuator
n May coat with cavity ____ or dentin bonding resin for ____ cement only
n ex. ____
n Mix cement according to manufacturers guidelines
varnish
non-adhesive
zinc phosphate
Procedure
n Apply thin coat of cement to clean restoration
n Be certain tooth is dry and push restoration into place
n ____ seating force
n Excess cement will escape from margins
rocking
Procedure
n Applying an orangewood stick with a ____ motion (or cotton roll) against the restoration ensures that all excess cement is expressed
n Avoid ____ force
rocking
excessive
Procedure
n After casting is seated, check margins to verify restoration is fully in place
n May protect setting cement by covering with ____
nEx. Dryfoil
adhesive foil
Procedure
n When cement is fully ____, remove excess with explorer
nMay compromise cement integrity if remove too ____
n Dental floss with a ____ may be used to remove interproximal cement
set
early
knot
Procedure
n The sulcus should contain no cement once completed
n Check occlusion with ____ stock
n Cements take at least ____ hours to develop final strength
nChew carefully for ____ days
shim
24
1-2
Procedure
Resin Luting Agents
n Resin cement (Panavia) is dispensed and spatulated
n Cement sets if ____ is excluded, so should be spread over ____ surface
oxygen
large
Procedure
Resin Luting Agents
n Cement is coated with ____ gel to promote polymerization
oxygen-inhibiting
Preclinical Procedure
Cement #19 (Ketac Cem)
nPrepare tooth
nDab tooth dry with cotton pellets n(pulpal protection when close to pulp)
nShake bottle to loosen powder
n1 level spoonful of powder:____ drops liquid
nPlace powder and liquid on mixing pad or glass slab
nMix using metal or plastic spatula nAdd powder to liquid in one portion
2
Preclinical Procedure
Cement #19 (Ketac Cem)
nContinue to smooth out paste until homogenous mixture is obtained
nApply thin coat of cement to inside crown (avoid overfilling crown)
n Times
nMixing: ____ min
n Application (incl. mixing): ____ min. 30 sec. nSetting from beginning mix: ____ minutes
nRemove excess after ____ minutes
1
3
7
7
Summary
nProper ____ control is essential for cementation
nRestoration must be carefully prepared for cementation
nAir ____ is recommended
nSeat restoration using rocking motion
nLuting agent must be protected from ____ during initial setting
moisture
abrasion
moisture
Introduction
n After placement and cementation of fixed dental prosthesis, patient treatment continues with carefully structured ____ of postoperative appointments
sequence
Introduction
n After placement and cementation of fixed dental prosthesis, patient treatment continues with carefully structured ____ of postoperative appointments
sequence
Introduction n Postoperative appointments nMonitor patient’s dental health n Stimulate meticulous \_\_\_\_ control habits nIdentify incipient disease nIntroduce \_\_\_\_ treatment, if needed
plaque
corrective
Introduction
n Patients should be instructed in special plaque control measures
nEspecially around ____ and connectors
n Need to educate regarding use of oral hygiene aids
nEx. ____ threaders
pontics
floss
Postcementation Appointments
n Appointment ____ days after FDP insertion
n To enable dentist to monitor function and comfort of prosthesis
n Verify proper plaque control
n Check sulcus for residual cement
n Check occlusion
7-10
Recall Appointments
n Especially important for patients with ____ restorations
n Should be carried out by ____
n Detecting disease around FDP difficult
n Partial dissolution of luting agent may be difficult to diagnose with ____ margins
n Often caries goes undetected until ____
extensive
dentist
subgingival
symptomatic
Recall Examinations
n If caries is overlooked, disease may rapidly progress
nNew ____ may be needed
nTooth loss may ____
prosthesis
result
Recall Appointments
n For cast restorations, should minimally be every ____ months
n If more extensive rehabilitation, more ____ appointments
n Can be coordinated with restorative dentist or ____
n Establish who will assume primary responsibility to coordinate appointments
6
frequent
periodontist
Recall Appointments nHistory and general examination nOral hygiene, diet and saliva nDental caries nIncluding \_\_\_\_ caries nPeriodontal disease nOcclusal dysfunction nPulp and periapical health
root
Emergency Appointments n \_\_\_\_ nLoose abutment retainer n Fractured \_\_\_\_ nFractured veneer
pain
connector
Summary
nWell-organized and efficient postoperative care is important to ensure optimal longevity and success in fixed prosthodontics
nA restoration which is neglected, is likely to fail regardless of quality of restoration
____ teeth require more meticulous plaque removal and maintenance than healthy teeth
nA fixed dental prosthesis requires additional care and attention
restored
Summary
nCommon complications after treatment
____, periodontal failure, ____ failure, loose retainers, porcelain fracture, root fracture
nDentist should anticipate long term prognosis and treatment needs and design treatment plan accordingly
nThe patient must understand the limitations of ____ before treatment begins
caries
endodontic
fixed prosthodontics
